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Les infections génitales hautes. Mise à jour des recommandations pour la pratique clinique – texte court

Abstract : Objectives: To provide up-to-date guidelines on management of pelvic inflammatory disease (PID). Methods:An initial search of the Cochrane database, PubMed, and Embase was performed using keywords related to PID to identify reports in any language published between January 1990 and January 2012, with an update in 2018. All identified reports published in French and English relevant to the areas of focus were included. A level of evidence based on the quality of the data available was applied for each area of focus and used for the guidelines. Results: PID must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade B). Pelvic ultrasonography is necessary to exclude tubo-ovarian abscess (TOA) (grade C). Microbiological diagnosis requires endocervical and TOA sampling for molecular and bacteriological analysis (grade B). First-line treatment for uncomplicated PID combines ceftriaxone 1 g, once, by intra-muscular (IM) or intra-venous (IV) route, doxycycline 100 mg × 2/d, and metronidazole 500 mg × 2/d oral (PO) for 10 days (grade A). First-line treatment for complicated PID combines IV ceftriaxone 1 to 2 g/d until clinical improvement, doxycycline 100 mg × 2/d, IV or PO, and metronidazole 500 mg × 3/d, IV or PO for 14 days (grade B). Drainage of TOA is indicated if the collection measures more than 3 cm (grade B). Follow-up is required in women with sexually transmitted infections (STI) (grade C). The use of condoms is recommended (grade B). Vaginal sampling for microbiological diagnosis is recommended 3 to 6 months after PID (grade C), before the insertion of an intra-uterine device (grade B), before elective termination of pregnancy or hysterosalpingography. Targeted antibiotics on identified bacteria are better than systematic antibioprophylaxis in those conditions. Conclusions: Current management of PID requires easily reproducible investigations and antibiotics adapted to STI and vaginal microbiota.
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Submitted on : Wednesday, June 12, 2019 - 3:04:52 PM
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J.-L. Brun, B. Castan, B. de Barbeyrac, C. Cazanave, A. Charvériat, et al.. Les infections génitales hautes. Mise à jour des recommandations pour la pratique clinique – texte court. Gynécologie Obstétrique Fertilité & Sénologie, Elsevier, 2019, 47 (5), pp.398-403. ⟨10.1016/j.gofs.2019.03.012⟩. ⟨hal-02153804⟩



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